Using TeamSTEPPS™ to Make Safety Improvements
Slide Presentation
A national technical assistance conference call conducted on March 31, 2010, provides users with an overview of the development of the survey. In addition, two professionals share their success and challenges in survey administration from both a regional perspective and an individual nursing home, and discuss how to maximize survey response and use survey results to develop action plans to target safety culture improvement initiatives. This is one of the sets of speaker slides from the call.
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- Using TeamSTEPPS to Make Safety Improvements.
- Medicare Quality Improvement Organizations.
- Medicare Quality Improvement Organizations.
- Data Collection Methods.
- Data Collection Methods.
- Implementation Procedures.
- Dear Administrator .
- Implementation Procedures.
- Wanted: Dedicated Health Care Workers .
- Timeline.
- Scheduling the survey.
- Collecting the survey.
- AHRQ Survey of Patient Safety—Nursing Homes.
- Average % of Positive Responses.
- NH Report.
- Nursing Home Recommendation.
- Overall Perceptions Of Resident Safety.
- Final report.
- Follow up.
- Lessons Learned: AHRQ Survey.
- Improvement Initiatives.
- TeamSTEPPS in Georgia.
- Performance.
- TeamSTEPPS in Georgia Nursing Homes.
- TeamSTEPPS in Georgia Nursing Homes.
- TeamSTEPPS: Making it Stick.
- Lessons Learned: TeamSTEPPS Training.
- GMCF: The Medicare Quality Improvement Organization for Georgia.
Slide 1. Using TeamSTEPPS to Make Safety Improvements
Tara Brown, MPH,CQIA, CQA
Evaluation Specialist
Georgia Medical Care Foundation
The Medicare Quality Improvement Organization for Georgia
National Technical Assistance Conference Call on the AHRQ Nursing Home Survey on Patient Safety Culture
March 31, 2010
Slide 2. Medicare Quality Improvement Organizations
- Congress created the Medicare QIO program in 1982.
- QIOs are the largest federal investment in health care quality improvement.
- QIOs work with thousands of health care professionals in 53 states and territories.
Slide 3. Medicare Quality Improvement Organizations
- Quality Improvement Organizations (QIOs) are staffed by nurses, physicians, biostatisticians, epidemiologists, long-term care administrators, pharmacists, public health, quality and communications professionals.
- Every 3 years, Medicare launches a new "Statement of Work" or SOW, with new assignments for QIO contractors.
- AHRQ survey completion was part of our 9th SOW for nursing homes and hospitals.
Slide 4. Data Collection Methods
- 72 Nursing Homes (NH).
- All staff members invited to take survey.
- Paper surveys/SurveyMonkey.
- Various times of the day (shift changes, special events at the NH).
- Drop box provided:
- Evening and weekend shifts.
Slide 5. Data Collection Methods
- Point of Contact (POC):
- Nursing Home (NH) Administrator:
- Support for survey critical.
- Some Admin assigned other POC:
- Education coordinator.
- DON/ADON.
- MDS coordinator.
- Nursing Home (NH) Administrator:
Slide 6. Implementation Procedures
- Georgia Health Care Association (GHCA):
- Announced the roll-out of survey to GHCA members.
- Corporate support from major companies.
- Letter to Administrator requesting support:
- Blast E-mails to staff.
- Announcements in staff meetings.
- Prizes for participation.
Slide 7. Dear Administrator
Image: Sample letter sent to nursing home administrators regarding the Nursing Home Survey.
Slide 8. Implementation Procedures
Items sent with letter:
- Copy of survey tool.
- Posters.
- Timeline for implementation.
Slide 9. Wanted: Dedicated Health Care Workers
Image: Photograph of the posters distributed in the nursing homes. "WANTED" Dedicated Health Care Workers...Take the Patient Safety Survey... Your Opinion Counts
Slide 10. Timeline
Nursing Home Survey of Patient Safety Culture
| Dates or Deadlines | Nursing Home | GMCF |
|---|---|---|
| 4/15/09 | Letter to Administrators introducing survey | |
| 4/16-4/24/09 | Quality Advisor follow-up with NH Administrators | |
| 4/20/09 | Poster and Staff letters distribution to NH (promotional purposes) | |
| 4/22-4/30/09 | Coordination of dates/times for survey completion within nursing homes | |
| 4/22-6/5/09 | Nursing Home Survey of Patient Safety Culture completion | |
| Summer 2009 | GMCF to provide analysis of AHRQ Survey of Patient Safety Culture | |
| By August 2009 | Facility representatives and a GMCF Quality Advisor will develop an action plan to address issues identified from the survey results. | |
| Quarterly | Attendance at Cross setting meeting with other providers in the local community of care. | |
| 5/1/2010-6/30/2010 | Re-measurement using AHRQ Survey of Patient Safety | |
Monthly:
Watch for the GMCF eLerts with the information you need to stay current.
GMCF offers educational teleconferences for providers related to pressure ulcer prevention/treatment and alternatives to restraints.
For the first three months of a new cross-setting meeting, there will be monthly meetings and quarterly thereafter.
Quarterly:
GMCF will contact the Administrator or designee for a one-on-one discussion.
Annually:
GMCF will re-measure using the Nursing Home Survey of Patient Safety Culture.
Slide 11. Scheduling the survey
- April 2009-June 2009:
- Calendar of events.
- Inservice days.
- Shift change.
- Special events.
- Publicize:
- Posters with dates.
Slide 12. Collecting the survey
- Voluntary & confidential.
- Giveaways.
- QIO staff present in the NH on day of survey.
Image: Button states, "I'm Dedicated to Patient Safety!"
Slide 13. AHRQ Survey of Patient Safety—Nursing Homes
- 72 Nursing Homes completed survey.
- Stats:
- 4,040 staff responded to survey.
- 7,148 were employed by these homes.
- 57% Response rate.
Image: Pie Chart shows the number of staff by title:
45% CNA [certified nursing assistants]
23% support staff
20% other
12% administrators/managers
Slide 14. Average % of Positive Responses
Image: Bar chart shows the overall positive percentage for each category of the NH survey. In order from most positive to least positive: Overall perceptions of resident safety was most positive followed by feedback and communication about incidents, then supervisor expectations and actions promoting resident safety, then training and skills, then organizational learning, then compliance with procedures, then management support for resident safety, then teamwork, then handoffs, then nonpunitive response to mistakes, then staffing, and lastly, communication openness.
Slide 15. NH Report
Table 1
| Nursing Home Patient Safety Culture Composites | Home Score: Average % of positive responses |
|---|---|
| Overall Perceptions of Resident Safety (3 items—% Agree/Strongly Agree) |
72% |
| Feedback & Communication About Incidents (4 items—% Most of the time/Always) |
78% |
| Supervisor Expectations & Actions Promoting Resident Safety (3 survey items—% Agree/Strongly Agree) |
71% |
| Organizational Learning (4 survey items—% Agree/Strongly Agree) |
63% |
| Management Support for Resident Safety (3 survey items—% Agree/Strongly Agree) |
59% |
| Training & Skills (3 items—% Agree/Strongly Agree) |
70% |
| Compliance with Procedures (3 items—% Agree/Strongly Agree) |
63% |
| Teamwork (4 items—% Agree/Strongly Agree) |
44% |
| Handoffs (4 items—% Most of the time/Always) |
45% |
| Communication Openness (3 items—% Most of the time/Always) |
40% |
| Nonpunitive Response to Mistakes (4 items—% Agree/Strongly Agree) |
53% |
| Staffing (4 items—% Agree/Strongly Agree) |
35% |
* Composite scores are not calculated when any item in the composite has fewer than three respondents.
Slide 16.
Image: Two bar graphs from the Nursing Home report developed by GMCF showing the nursing homes' response to Survey item E1 (would tell friends nursing home is safe) and Survey item E2 (overall safety rating).
Slide 17. Overall Perceptions Of Resident Safety
Image: Bar graph from Nursing Home report developed by GMCF shows the nursing homes' item-level responses regarding overall perception of patient safety and feedback about incidents with 3-point bar chart for percent positive, neutral, and negative.
Slide 18. Final report
Results/report delivered to Nursing Home (based on NH Admin feedback):
- Most reviewed with management team.
- Some reports reviewed with all NH staff.
- Small number of NH where just the Admin received report.
Slide 19. Follow up
QIO Quality Advisors:
- Developed Action Plans.
- Encouraged attendance at cross-setting meeting with other providers from the local community of care.
- Facilitated teams for change.
- Provided targeted training.
Slide 20. Lessons Learned: AHRQ Survey
- Paper surveys are labor intensive.
- Buy-in from management is a must.
- Partnerships with local Health Care Association and corporations essential.
- Offer prizes/giveaways.
- Low literacy/reading levels challenge completion by some staff:
- Group/oral reading.
Slide 21. Improvement Initiatives
- Targeted Training:
- Training on TeamSTEPPS:
- Addresses communication, handoffs, teamwork.
- Training/support in individual nursing homes (NH) and for larger groups of NH.
- Training on TeamSTEPPS:
Slide 22. TeamSTEPPS in Georgia
Why use?
- 9th Statement of Work (SOW) required use of TeamSTEPPS for hospitals working to reduce MRSA.
- Concepts included in TeamSTEPPS applicable to all settings:
- Leadership.
- Communication.
- Mutual Support.
- Situation Monitoring.
Slide 23. Performance
Image: The TeamSTEPPS framework. It is a triangle shape with performance at the top, with knowledge in the bottom left corner, and attitude in the bottom right corner. These three components have arrows pointing toward and from a circle in the center of the triangle. The circle has a border called patient care team and then the center of the circle reads skills and has four components: leadership, communication, mutual support, and situation monitoring.
Slide 24. TeamSTEPPS in Georgia Nursing Homes
- Introduced at kickoff meetings in Fall 2008 with 3-hour training session.
- Provided copies of "Our Iceberg is Melting," by John Kotter.
- Group training sessions in 2009 (eight sessions twice yearly) using TeamSTEPPS.
- Quarterly Cross-Setting Meetings.
- Individual NH support.
Slide 25. TeamSTEPPS in Georgia Nursing Homes
"Our Iceberg is Melting" model includes:
- Creating a Sense of Urgency.
- Pulling together a Guiding Team.
- Develop the Change Vision and Strategy.
- Communicate for Understanding and Buy-In.
- Empower Others to Act.
- Produce Short-Term Wins.
- Don't Let Up.
- Create a New Culture.
Slide 26. GMCF: The Medicare Quality Improvement Organization for Georgia
- Continue training to Nursing Homes using TeamSTEPPS concepts throughout the 9th Statement of Work (SOW).
- Individualized follow-up/support.
- Quarterly cross-setting meetings focus on communication and handoffs in local health care community.
Slide 27. Lessons Learned: TeamSTEPPS Training
- Interactive sessions work best.
- Presenters modeling the "team" concept is powerful.
- Scenarios customized to the participant's job experience work wonders.
- Evaluating responses and debriefing your meetings are essential.
- Nursing Homes are applying these principles and tools—one Quality Advisor states "we see it every time we visit a facility that has been a part of the training".
Slide 28. GMCF: The Medicare Quality Improvement Organization for Georgia
Tara Brown, MPH, CQIA, CQA
Evaluation Specialist
Tarabrown@gmcf.org
This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 9SOW-GA-PSF-10-17
